- For resection specimens with carcinoma, including squamous cell carcinoma, adenocarcinoma and variants, carcinosarcoma, neuroendocrine carcinoma, and mixed epithelial – neuroendocrine tumors. Summary recommended but not required for biopsy specimens. Not used for lymphoma or sarcoma.
Specimen and Surgical Procedure
Specimen, procedure.....................................................................
Lymph nodes submitted and/or identified in the specimen.................. yes/no
Tumor
Tumor site................................................................................... upper third/middle third/lower third/not specified
Tumor size................................................................................... ___ cm
Histologic type..............................................................................
Histologic grade...............well/moderately/poorly differentiated/undifferentiated
Other tissue/organ involvement.....................................................
Lymphovascular invasion................................................not identified/present
Final Margins
Peripheral margin
Invasive carcinoma at margin .uninvolved/involved (specify location(s):)
Intraepithelial neoplasia at margin .uninvolved/involved by high-grade squamous intraepithelial lesion (VAIN 2-3)/involved by adenocarcinoma in situ
Deep margin
Invasive carcinoma at margin .uninvolved/involved (specify location(s):)
Intraepithelial neoplasia at margin .uninvolved/involved by high-grade squamous intraepithelial lesion (VAIN 2-3)/involved by adenocarcinoma in situ
Lymph Nodes* (required only if lymph nodes are present in specimen)
Total number of nodes examined: _____
Specify site(s)#: ____________________________
# Note: Information should include location and laterality of lymph nodes examined.
Specify lymph node(s) with tumor#: ____________________________
# Note: Information should include location and laterality of lymph nodes with tumor.
Number of nodes with metastasis (excludes ITCs): _____
Number of nodes with isolated tumor cells (ITCs) (0.2 mm or less): _____
Pathologic stage (AJCC 8th ed.)...................................................pT__N__M__